Para-aortic lymphadenectomy improves survival in patients with intermediate to high-risk endometrial carcinoma.
OBJECTIVE
Surgical staging of endometrial carcinoma is practiced to identify the true extent of disease. The impact of para-aortic lymphadenectomy (PALD) on survival is unproven. The purpose of this study was to determine if a staging procedure that includes PALD is associated with improved survival in endometrial carcinoma patients who had been surgically staged.


METHODS
Retrospective review of patients' records.


METHODS
Ajou University Hospital, a tertiary care hospital in South Korea.


METHODS
One hundred and sixty patients with endometrial carcinoma.


METHODS
We retrospectively analyzed a total of 160 FIGO stage I-III endometrial carcinoma patients without grossly metastatic para-aortic lymph nodes, who underwent surgery between 1994 and 2007. Exclusion criteria included presurgical radiation, stage IV disease and sarcomas. Two groups were identified: patients who underwent pelvic lymphadenectomy (PLD) and PALD (n=85) versus those who underwent PLD alone (n=75). Survival was analyzed using Kaplan-Meier method and Cox proportional hazards model.


METHODS
Disease-free and overall survival.


RESULTS
Overall, patients who underwent PALD demonstrated improved 5-year disease-free survival (81.0 vs 91.2%) and overall survival (85.8 vs 96.2%) compared to those who underwent PLD alone (p=0.019 and p=0.039, respectively). After multivariate analysis, patients' age (p=0.028), FIGO stage (p<0.001) and lymphadenectomy (p=0.014) were independent prognostic factors. The type of lymphadenectomy did not affect survival of low-risk patients. In intermediate to high-risk patients, PALD improved disease-free survival and showed a trend toward improvement of overall survival.


CONCLUSIONS
These data demonstrate that PALD has a potentially therapeutic benefit on survival in surgically staged patients with intermediate to high-risk endometrial carcinoma.
Chang
Suk-Joon
SJ
Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, South Korea.
Kim
Woo Young
WY
Yoon
Jong-Hyuck
JH
Yoo
Seung-Chul
SC
Chang
Ki-Hong
KH
Ryu
Hee-Sug
HS
D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010388:Pelvis; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate